结核毁损肺胸膜全肺切除术后并发心律失常的危险因素分析

Risk Factors of Cardiacarrhythmia Associated with Pleuropneumonectomy for Destroyed Lung of Tuberculosis

目的研究结核性毁损肺患者接受单侧胸膜全肺切除术后并发心律失常的情况以及危险因素的分析，从而为此类患者的术前准备和围手术期治疗提供指导。方法选择2008年6月～2010年6月肺结核毁损肺患者接受胸膜全肺切除术52例，手术后出现心律失常32例，为观察组，未出现心律失常20例为对照组，单因素分析和多因素分析（Logistic回归）导致结核毁损肺胸膜全肺切除术后出现心律失常的原因，并比较心律失常组与对照组在住院时间、住院费用方面的差异。结果52例肺结核毁损肺患者接受胸膜全肺切除术，32例出现心律失常，占61．5％，多为室上性心动过速，且多发生在手术后1周内。经过单因素分析，患者的年龄、手术前FEV1％（1秒钟用力呼吸容积预测值，forced expiratory volume in one second of the predicted value）下降、手术中出血量、手术后低氧血症是结核毁损肺胸膜全肺切除术后并发心律失常的相关因素，其中手术中出血量和手术后低氧血症为危险因素。心律失常组与对照组比较住院时问延长，住院费用增加。结论肺结核毁损肺接受胸膜全肺切除术患者围手术期应重点治疗手术中出血，加强手术后低氧血症的监测与治疗，维护手术后患者的循环及氧合的稳定，提高围手术期患者的救治成功率。

Objective To investigate the risk factors of cardiacarrhythmia associated with patients who received the pleuropneumonectomy operation for single destroyed lung of tuberculosis and to guide preoperative preparation and treatment in perioperative period for those patients. Methods 52 patients with single destroyed lung of tuberculosis after pleuropneumonectomy hospitalized from June 2008 to December 2009 were enrolled. There were 32 cases with cardiacarrhythmia as a treatment group and 20 cases with no cardiacarrhythmia as control. The factors of cardiacarrhythmia were analyzed with the univariate analysis and multivariate analysis （logistic regression analysis） for patients with single destroyed lung of tuberculosis after pleuropneumouectomy. The length of stay and expenditure in hospital were compared between these two groups. Results Of 52 cases who received pleuropneumonectomy for single destroyed lung of tuberculosis, 32 cases （61.5%） developed cardiacarrhythmia which was supravenwicular tachycardia and taken place in the first week after operation among most patients. The age, FEV1, peroperative bleeding amount, postoperative hypoxemia are associated with cardiacarrhythmia after operation using univariate analysis. Peroperative bleeding amount, postoperative hypoxemia were risk factors of cardiacarrhythmia after operation. The length of stay and expenditure were more increased in the treatment group than those in the control. Conclu^loa We should pay more attention to monitor and treat peroperative bleeding and postoperative hypoxemia for patients in perioperative period in order to maintain the stability of circulatory system and oxygenation index and to improve successful rate of patients during perioperative period.